Eating Disorders Affect Oral Health

The National Eating Disorders Association (NEDA) estimates that in the United States, nearly 10 million women and 1 million men are affected by anorexia or bulimia. Millions more suffer from binge-eating disorders. With so many men and women suffering from eating disorders, more dentists are becoming the first line of defense when it comes to recognizing these problems in patients. Although parents may not know that their children have an eating disorder, they often ensure that their children have regular dental appointments. In such cases, a dentist may spot the warning signs of an eating disorder and be able to point parents in the right direction to get help.

Anorexia and bulimia nervosa have a profound effect on the teeth. Well known dental consequences of these disorders are:

• Eventual tooth loss.
• Erosion of the enamel on the "tongue side" of the teeth as a result of teeth being bathed in stomach acid.
• Worn-away enamel, which make dental fillings appear to be raised and teeth appear dark.
• Possible bone loss from osteoporosis.
• Jagged edges on the biting surfaces of the top teeth.
• Altered bite such that lower teeth hit the roof of the mouth.
• Bleeding gums and burning tongue.
• Decreased salivary flow (dry mouth) and swollen glands.
• Sensitivity and soreness in the teeth, mouth, throat, tongue and gums.

Because teeth and gum tissue reflect a person's health, the dentist may be the first to detect an eating disorder. Too often, neither the medical community nor the patients realize the serious impact that eating disorders have on teeth. Irreversible damage -- even total loss of all teeth -- is possible if left untreated. Some dental offices work with health professionals in their area that treat patients' eating disorders, specifically anorexia and bulimia nervosa, because dental care is part of the recovery program.

A key element in this treatment program is education. For patients with eating disorders, we do not recommend the standard dental hygiene guidelines. For example, since many bulimic patients follow a pattern of binge eating then purging, often regurgitating food and stomach acid, it is important that they do not brush their teeth afterwards. Doing so would only encourage even more erosion of the dental enamel because the patient would actually be scrubbing his or her teeth with acidic solution. In such cases, we suggest that our patients simply rinse their mouth with water or with a solution of sodium bicarbonate (baking soda and water). The baking soda rinse neutralizes the acid by raising the pH level in the mouth. Brushing the tongue with baking soda may also be recommended.
Dental treatments can and should begin during recovery in order to protect the teeth. If diagnosed and treated at an early stage, enamel loss may be replaced with tooth-colored materials known as composite resins. These resins are sculpted into place -- duplicating or improving the appearance of the missing enamel.

In some cases more extensive dental treatment may be required, depending upon the extent of the damage to the teeth. There may be the need for dental restorations, such as overlays, tooth crowns or veneers, especially if a proper bite needs to be achieved.

Sometimes, eating disorders are not discovered until it is too late and irreversible damage has been done to the body as well as the teeth. According to NEDA, early detection of the disease may ensure a successful recovery period for the body and teeth.